Changes would leave little time for nurses to teach and learn

9:31 November 14, 2011

Dr Jennifer Newton

At the heart of this fight is nurse-patient ratios — the government wants them increased, the nurses want to keep the status quo of one nurse to four patients.

What is being forgotten is that our health system is also a learning environment. Registered nurses and midwives in particular, play a crucial role in workplace training and fiddling with ratios could undermine that important element of our system.

Historically nurses and midwives have always taken on the mantle of ”the teacher” within the hospital system. They have supervised junior staff, acted as role models and assisted new medical interns in finding their feet. The clinical work-based learning that they facilitate is essential in enabling students and new graduates to transition into the workplace.

With advancements in technology and pharmacology, the complexity and acuity of the patients that as a practising nurse I now care for is far greater than it was 30 years ago (when I began in the hospital system) This is adding to pressure on the workplace learning in a healthcare setting.

For individuals to participate and learn in such a complex environment there needs to be partnerships between experienced practitioners and novices. A learning partnership is influenced by individuals and their personal values and beliefs; the recognition of the workplace as an environment where one has the ability to share knowledge and learn is paramount. This may be undermined, however, by social and workplace tensions that can exist between co-workers.

So it is with some concern that I reflect on the respective proposed productivity improvements of both the state government and the ANF. The government is offering to reduce the ratio of registered nurses to patients on wards and replace some nurses with low-skilled ”health assistants” and in return for these changes, grant nurses a pay rise of just 3.5 per cent. The ANF is seeking a parity of wages with their interstate colleagues and an improvement in mandated minimum ratios in areas such as aged care, palliative care as well as rapid assessment units to improve patient care in such facilities. If Victorian nurses want a pay rise more than 2.5 per cent then they may well find themselves experiencing split shifts due to the reduced registered nurse ratio. This is surely going to impact on the ability of nurses or midwives to mindfully engage with each other in a learning partnership and with students or new graduates.

A key element that enhances a learning partnership is its continuity. With practitioners coming and going as their half-shift ends, where will this leave the undergraduate student who is undertaking their clinical placement experience? Standing in a clinical unit with no one to supervise them?

Research from Monash University this year shows that many nurses are focused on ”getting the work done” and are too busy to support novices. That is with a nurse-patient ratio of 1:4 and current shift patterns. What will an increase in patient ratio do to those informal moments of sharing knowledge and learning that are so essential in creating a learning partnership and instilling a culture of learning?

If a multi-tiered nursing care system, with health care assistants, enrolled nurses and registered nurses, is introduced, tensions between workers could escalate as staff juggle who is providing what care to their patient or client. This would not bode well in creating an environment conducive to learning.

The Baillieu government has indicated that there is a strong demand for labour in the sector as the patient demand for health service increases. A leaked cabinet–in-confidence paper states: ”The degree of change experienced by a health professional through technological advancement easily surpasses that experienced by other professionals such as teachers or lawyers.” Yet it would seem that neither the government nor the health services value the degree of tertiary learning that our nurses and midwives undertake in order to practice in today’s healthcare system.

It is surprising that the ANF is not using the extensive workplace learning that is critical to the development of new nurses and midwives to help justify an increase in the nurses’ pay award.

To put the pay dispute in perspective, how can it be that as a registered nurse, with degree qualifications, more than 30 years’ experience and a daily responsibility for the care of vulnerable and unwell individuals, I can be paid $32 an hour before tax, but the man who mows my lawns can charge me $40 an hour?

In recent years, Victoria has succeeded in winning additional funded university places for nurses and other professionals. These places, however, will be redundant if the healthcare workplace is unable to support and engage students and or new graduates in learning. At the moment, healthcare services struggle to accommodate the demand for clinical learning placements, not only for nurses and midwives but also other health professional students. But with the proposed productivity improvements being pushed by the Baillieu government, I see little time for learning to occur in the workplace.

Dr Jennifer Newton, RN, RM, is a senior research fellow in a conjunct appointment between the School of Nursing and Midwifery and the School of Primary Health Care at Monash University.

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